Can’t Sleep Can’t Sleep
Complementary and Alternative Medicine at the National Institute of Health, National Institute on Aging

A good night’s sleep is more than a luxury. Sleep is as important to survival as food and water. On too little, we humans don’t function well—for example, we run a higher risk of accidents, we sometimes perform poorly at work or school, and our moods can turn sour.

A sleepless night or two isn’t a medical emergency. However, if difficulties persist, a sleep disorder may be involved. People with sleep disorders may have difficulty falling or staying asleep or waking up in the morning, fall asleep at inappropriate times, sleep too much, or show unusual behaviors during sleep. Important new research, including studies supported by the National Institutes of Health (NIH), has linked lack of sleep with obesity, diabetes, and other related conditions. The National Center for Complementary and Alternative Medicine (NCCAM) is supporting a number of research studies on potential treatment options for sleep disorders using complementary and alternative medicine (CAM).

"Sleep disorders are an important public health issue that is receiving serious attention from NCCAM and several other components of NIH," said NCCAM Director Stephen E. Straus, M.D.

As many as 70 million Americans—about one-quarter of the population—experience sleep disorders; half of this group have chronic sleep problems. Conventional therapies are available for most sleep disorders, but for some people they don’t work well, cause unwanted side effects, or cost too much. As a result, many people turn to CAM therapies.

According to the 2002 National Health Interview Survey, 2.2 percent of all adults in the survey who used CAM did so for sleep problems. This represents approximately 1.6 million U.S. adults. CAM therapies commonly used for sleep problems include dietary supplements (such as melatonin and valerian); approaches that emphasize the interaction between the mind and the body (such as meditation); and therapies that are part of non-Western traditional medical systems (such as acupuncture and yoga).

"While some CAM products used to treat sleep disorders are already available to consumers, in most cases they have not been proven to be efficacious through rigorous research," explained Nancy J. Pearson, Ph.D., NCCAM Program Officer and member of the Trans-NIH Sleep Research Coordinating Committee. "There is very little knowledge about whether CAM therapies for sleep disorders work, and, if so, how they work. NCCAM is supporting research to help answer these questions."

Types and Causes of Sleep Disorders

Sleep problems can start with a sudden event. For example, a job loss can lead to nighttime worries, which in turn can lead to trouble sleeping. When a sleep problem occurs without another identified disease or condition, it is referred to as a primary sleep disorder. However, in many cases, sleep disorders are associated with other causes. Some circumstances and illnesses that can lead to sleep problems are as follows:

Because of lifestyles or work schedules, sleep just isn’t a priority for some people. Stress from hectic schedules can make it difficult to relax and fall asleep. The body’s internal clock programs people to feel sleepy during the nighttime and to be active during daylight hours. When that clock goes off-kilter, sleep becomes difficult. For example, travelers who fly across multiple time zones quickly get "jet lag" because they cannot maintain a regular sleep-wake schedule. People who work at night and try to sleep during the day are constantly fighting their internal clocks. This puts them at risk for disturbed sleep. Without adequate rest, they are more likely to make errors or have accidents at work. Sleep disorders often occur in people who have a chronic disease that involves pain or infection, a neurological or psychiatric disorder, or an alcohol or substance abuse disorder. (These are sometimes called secondary sleep disorders.) For these individuals, sleep becomes difficult, potentially worsening the other medical condition, and affecting the person’s health and safety, mood and behavior, and quality of life.

Sleep problems can arise during any period of life:

In children, inadequate sleep may lead to daytime sleepiness, which can interfere with a child’s ability to learn in school and perform well in other activities. Sleep-deprived children may also tend to fall or have other accidents that lead to injury. Many children who are chronically deprived of sleep may not seem sleepy and may even appear to be overactive. Chronic sleep loss in these children may be overlooked or mistakenly attributed to hyperactivity or other behavior disorders. Teenagers are notorious for getting too little sleep as they burn the midnight oil to study for exams or socialize late into the night. Body clocks actually shift during these years, so teens often stay up late and sleep beyond the morning hours. This tendency, when combined with an increased need for sleep in adolescence and an early first bell at most high schools, can put teenagers at risk for sleep disorders. Women going through the menopausal transition are more likely to experience sleep problems than are other women. Older adults’ sleep is often easily disturbed by noise and other environmental factors. Older people are also more likely to have chronic health conditions or pain that make it more difficult for them to get into the deep, restful stages of sleep. Certain medical conditions, such as rheumatoid arthritis, Parkinson’s disease, or chronic pain, may contribute to sleep problems.

The Most Common Sleep Disorders

Below are some of the most common sleep disorders. Medications and behavioral approaches are available to help people with these disorders.

Insomnia is difficulty falling and staying asleep, as well as daytime problems associated with sleepiness. It is the most commonly reported sleep complaint. Insomnia often accompanies stress or another health condition.

Frequent loud snoring at night and daytime sleepiness are the main symptoms of sleep apnea. People with sleep apnea stop breathing for brief periods while asleep and then choke and gasp for breath.

People with narcolepsy cannot regulate their sleep/wake cycles. As a result, they may fall asleep uncontrollably—any place, any time. These "sleep attacks" are often accompanied by daytime sleepiness, episodes of muscle weakness or paralysis, and disrupted nighttime sleep.

In restless legs syndrome, a person has tingling sensations in the legs while sitting or lying still. They constantly stretch or move their legs to try to relieve these sensations, which interfere with sleep.

NCCAM Research

NCCAM supports studies on whether certain CAM therapies might be helpful for sleep disorders. Some examples:

University of Washington researchers are testing the herb valerian in healthy older adults who experience sleep disturbances. At Emory University, valerian is being studied in people with Parkinson’s disease, and at the University of Virginia, it is being studied in people with rheumatoid arthritis. Researchers at Brigham and Women’s Hospital in Boston are studying a program of yoga and relaxation exercises as a treatment for insomnia. University of Chicago researchers are studying the mechanisms of action of hops, an herb that has been used both alone and in combination with valerian for sleep problems. A preliminary study at Brigham and Women’s Hospital will determine the mechanism of action of vitamin B12 as a treatment for a form of delayed sleep phase syndrome that affects more than half of blind individuals and is also common in sighted individuals. In delayed sleep phase syndrome, a person’s internal body clock is out of sync, causing difficulty falling asleep until very late at night and difficulty waking up in the morning. Researchers at the University of Pennsylvania are comparing the effects of a low-dose melatonin supplement, a high-dose melatonin supplement, and a placebo in elderly people who have insomnia and a low level of natural melatonin in the body. At the University of North Carolina, researchers are investigating whether high-intensity light, installed in common areas in a nursing home, could lessen the problems of sleep/wake disorders, depressive symptoms, and agitation—all frequent, difficult issues for people with Alzheimer’s disease. At Harvard University, researchers are studying the effects of blue light therapy on sleep cycles. At the University of Arizona, researchers are examining the impact of two different homeopathic remedies on sleep patterns in adults.

Along with supporting studies, NCCAM also participates in other activities to improve the state of scientific knowledge about treatments for sleep disorders. First, NCCAM is part of the Trans-NIH Sleep Research Coordinating Committee, which coordinates research efforts across NIH and issues a report each year. NCCAM is supporting—along with 12 other NIH institutes, centers, and offices—an initiative to stimulate research on sleep and sleep disorders.

Second, NCCAM cosponsors conferences and workshops on areas related to sleep disorders. In 2004, NCCAM cosponsored a conference on the biology of the brain’s pineal gland, which produces melatonin. In June 2005, NCCAM was one of several sponsors of the State-of-the-Science Conference on insomnia at NIH. At that conference, the invited panel of experts called for further research on commonly used CAM treatments for insomnia, including supplements like melatonin and valerian, and mind-body practices such as tai chi and yoga. Acupuncture and light therapy were also mentioned as treatments that call for additional evaluation.

Because the use of melatonin supplements by the public for sleep problems is widespread, NCCAM requested and funded a report published by the Agency for Healthcare Research and Quality that analyzed the existing scientific evidence on this topic. The authors found that melatonin appears safe for short-term use, but that it may not be effective for treating most primary sleep disorders, such as jet lag. It may offer some benefit for delayed sleep phase syndrome. How melatonin works in humans is not well understood, and more research is needed to answer many questions about this therapy.

"Many people struggle with getting enough sleep or the right kind of sleep," said Dr. Pearson. "Better sleep improves our quality of life. NCCAM, on its own and in collaboration with other institutes and centers at NIH, is committed to supporting research to uncover potential new options from CAM for those with sleep problems."

Tips for Better Sleep

Follow a regular sleep schedule. It is helpful to go to sleep and wake up at the same times as much as possible, even on weekends. Exercise at a regular time each day, at least 3 hours before bedtime. Get some natural, outdoor light each day. Avoid caffeine late in the day. Don’t drink alcohol to help you sleep. Avoid smoking. Create a safe and comfortable place to sleep (quiet, dark, and well ventilated). Develop a nighttime routine that helps you slow down and relax. If you’re having trouble falling asleep after about 15 minutes, get up, do a quiet activity, and return to bed when you are sleepy. Try these tips and record your sleep and sleep-related activities in a sleep diary. If problems continue, discuss the sleep diary with your doctor.